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Stomach Cancer Stomach Cancer What is stomach cancer? Let us explain it to you. www.anticancerfund.org www.esmo.org ESMO/ACF Patient Guide Series based on the ESMO Clinical Practice Guidelines STOMACH CANCER: A GUIDE FOR PATIENTS PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES This guide for patients has been prepared by the Anticancer Fund as a service to patients, to help patients and their relatives better understand the nature of stomach cancer and appreciate the best treatment choices available according to the subtype of stomach cancer. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of disease. The medical information described in this document is based on the clinical practice guidelines of the European Society for Medical Oncology (ESMO) for the management of stomach cancer. This guide for patients has been produced in collaboration with ESMO and is disseminated with the permission of ESMO. It has been written by a medical doctor and reviewed by two oncologists from ESMO including the lead author of the clinical practice guidelines for professionals. It has also been reviewed by patients’ representatives from ESMO’s Cancer Patient Working Group. More information about the Anticancer Fund: www.anticancerfund.org More information about the European Society for Medical Oncology: www.esmo.org For words marked with an asterisk, a definition is provided at the end of the document. Stomach cancer: a guide for patients - Information based on ESMO Clinical Practice Guidelines - v.2012.1 Page 1 This document is provided by the Anticancer Fund with the permission of ESMO. The information in this document does not replace a medical consultation. It is for personal use only and cannot be modified, reproduced or disseminated in any way without written permission from ESMO and the Anticancer Fund. Table of contents Definition of stomach cancer ..................................................................................................... 3 Is stomach cancer frequent? ...................................................................................................... 5 What causes stomach cancer? ................................................................................................... 6 How is stomach cancer diagnosed? ........................................................................................... 9 What it is important to know to get the optimal treatment? ................................................. 11 What are the treatment options? ............................................................................................ 14 What happens after treatment? .............................................................................................. 21 Definitions of difficult words .................................................................................................... 23 This text was written by Dr Annemie Michiels (Anticancer Fund) and reviewed by Dr. Gauthier Bouche (Anticancer Fund), Dr. Svetlana Jezdic (ESMO), Dr. Alicia Okines (ESMO), Prof. David Cunningham (ESMO), Dr. William Allum (ESMO) and Pr. Lorenz Jost (ESMO’s Cancer Patient Working Group). Stomach cancer: a guide for patients - Information based on ESMO Clinical Practice Guidelines - v.2012.1 Page 2 This document is provided by the Anticancer Fund with the permission of ESMO. The information in this document does not replace a medical consultation. It is for personal use only and cannot be modified, reproduced or disseminated in any way without written permission from ESMO and the Anticancer Fund. DEFINITION OF STOMACH CANCER This definition is adapted from and is used with the permission of the National Cancer Institute (NCI) of the United States of America. Stomach cancer is a cancer that forms in tissues lining the stomach. Most stomach cancers start from cells in the inner layer of the stomach (the mucosa) which normally make and release mucus* and other fluids. These cancers are called adenocarcinomas and represent about 90% of stomach cancers. Anatomy of the digestive system and layers of the stomach wall. The mucosa* or inner layer of the stomach is made up of the epithelium* and the lamina propria*. Going deeper in the stomach wall we find the submucosa*, followed by the muscle layers, subserosa* (not shown in the picture) and the serosa*. The serosa* is the membrane* covering the outside of the stomach. Stomach cancer: a guide for patients - Information based on ESMO Clinical Practice Guidelines - v.2012.1 Page 3 This document is provided by the Anticancer Fund with the permission of ESMO. The information in this document does not replace a medical consultation. It is for personal use only and cannot be modified, reproduced or disseminated in any way without written permission from ESMO and the Anticancer Fund. Important note regarding other types of stomach cancer The information provided in this Guide for Patients does not apply to other types of stomach cancers. The main other types of stomach cancer include: Gastric lymphomas, which are cancers originating from cells of the immune system found in the wall of the stomach. Most gastric lymphomas are non-Hodgkin lymphomas. More information on non-Hodgkin lymphoma can be found here. Gastro-intestinal stromal tumors or GIST, which are rare tumors that are believed to originate from cells in the wall of the stomach called interstitial cells of Cajal. Information on gastro-intestinal stromal tumor can be found here. Neuroendocrine tumors which are tumors originating from nervous or endocrine cells of the stomach. Information on gastric neuroendocrine tumors can be found here. Diagnosis and treatment of these types of cancer are different from those for gastric adenocarcinoma. Stomach cancer: a guide for patients - Information based on ESMO Clinical Practice Guidelines - v.2012.1 Page 4 This document is provided by the Anticancer Fund with the permission of ESMO. The information in this document does not replace a medical consultation. It is for personal use only and cannot be modified, reproduced or disseminated in any way without written permission from ESMO and the Anticancer Fund. IS STOMACH CANCER FREQUENT? Worldwide, stomach cancer is most common in East Asia, South America and Eastern Europe. It is less common in Western Europe even though stomach cancer is the fifth most frequent cancer in Europe. It is approximately twice as frequent in men as it is in women. It is most often diagnosed between the age of 60 and 80. In Europe, about 150,000 people developed stomach cancer in 2008. The marked variation in the frequency of stomach cancer between continents and countries is mainly due to differences in diet and to genetic factors. In Europe, an average of 1 or 2 in every 100 men and 0.5 to 1 in every 100 women will develop stomach cancer at some point in their lifetime. There are marked geographic variations between countries worldwide but also within Europe. Stomach cancer is more frequent in countries of Eastern Europe and in Portugal where up to 4 in every 100 men and 2 in every 100 women will develop the disease at some point in their lifetime. Stomach cancer: a guide for patients - Information based on ESMO Clinical Practice Guidelines - v.2012.1 Page 5 This document is provided by the Anticancer Fund with the permission of ESMO. The information in this document does not replace a medical consultation. It is for personal use only and cannot be modified, reproduced or disseminated in any way without written permission from ESMO and the Anticancer Fund. WHAT CAUSES STOMACH CANCER? Today, it is not clear why stomach cancer occurs. Some risk factors* have been identified. A risk factor* increases the risk of cancer occurring, but is neither sufficient nor necessary to cause cancer. It is not a cause in itself. Most people with these risk factors* will never develop stomach cancer and some people without any of these risk factors will nonetheless develop stomach cancer. The main risk factors* of stomach cancer are: Environmental factors: Helicobacter pylori or H. pylori is a bacteria and can reside in the stomach and cause chronic inflammation or stomach ulcers*. If this situation persists for a few decades, it can evolve into cancer. However, the infection will first go through a number of pre-cancerous stages (like atrophic gastritis, metaplasia and dysplasia) that could, but do not systematically turn into cancer. These stages can already be detected and treated before they could evolve to cancer. If left untreated, 1% of all patients with H. pylori will eventually develop stomach cancer. About 50% of the world’s population is infected with H. pylori. Transmission occurs through stools and saliva and is strongly related to poor socio-economic status and poor living conditions. Treatment of this infection consists of a cure with antibiotics. Infection with H. pylori is the most important and at the same time, one of the most treatable risk factors for stomach cancer. Lifestyle: o Nutrition: . A high dietary intake of salt, including salt- preserved (e.g. smoked or pickled with salt) food, strongly increases the risk of developing stomach cancer. The presence of salt makes an infection with H. pylori more likely to occur and also seems to aggravate the effect of an infection. Besides that, it damages the mucosa* of the stomach and can in this way directly contribute to the development of stomach cancer. A high intake of food containing nitrates* or nitrites*, like preserved
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